What about expats?

Before I start writing on my topic for today, let me say in advance that this is a real hot button issue for Americans.  I want to remind all readers and participants on LiP to please keep the discussion civil.  No name calling.  Please, let’s just focus in on how expats are affected, and not the debate of the issue itself.

Health care. It has been a major issue in the United States for decades now.  There was a big rush of activity in the early 90’s when President Bill Clinton tried to push through a National Health Care plan, with the effort being headed up by his wife, Hillary.  After the proposal was shot down in the early 90’s, the issue of a nationalized health care system kind of faded for a while, although issues like the cost of health care and such continued to be ever present.

With the new administration of President Obama, there has been a renewed push to get a National Health Care system in place in the United States.  In the past 24 hours, the U.S. House of Representatives has passed their Health Care Plan by a very slim 220-215 vote.  One Republican crossed to vote with the Democrats, so it can hardly be called a bipartisan effort.  The debate over health care now shifts to the U.S. Senate, where a bill has yet to be passed.  If the Senate passes Health Care legislation, the next step will be for the two houses to meet in a conference session to wrangle out the differences in the two bills that are passed.  After that, the final bill would be presented to the President for his signature.

I know what you are thinking…

But, Bob, you don’t live in the United States, why would you really care, and what does it have to do with Living in the Philippines?  Why are you writing about this?

Well, as the bill sits right now, it would seem that it might have an impact on expats living anywhere in the world, even in the Philippines.  Why?  How?

Under the House version of the bill, there is language that says that every American must have health care coverage.  In fact, if you do not purchase a health insurance plan, you are subject to a fine of $15,000, and if you do not pay that fine, you can be put in jail.  Yes, if the Health Care plan is signed into law as it is now written, you may be put in jail if you do not have Health Insurance.

What about expats?

The bill does not say “All Americans who live in the United States must have coverage.”  It says that “All Americans must have health insurance.”  So, what if you do not live in the United States?  I am an American, but I have not been in the United States for nearly a decade.  I do not have any kind of US Health Insurance coverage, because I have no plans to go to the USA for any kind of health care treatment.  I feel perfectly safe with the health care that is available to me in the Philippines.

There are only a few (actually I know of only one) Health Insurance plans available in the USA that will cover you for treatment in the Philippines.  The one that I am aware of is Tri Care, a plan for US Military Personnel and Retirees.  Other plans will cover you for emergency care in the Philippines, but not for regular health care for those who live here.  I am not saying that there are no such plans, only that I know of none.

Now, there are health care plans that you can avail of here.  If you have a Philippine spouse, you can get PhilHealth, the Philippine Government Insurance plan for your health.  It is very inexpensive (P1,200 per year!), but the coverage is also limited.  If I have PhilHealth Coverage, I wonder if the US would consider me to be in compliance with the proposed law?  I sort of doubt it.

So, will I, and others like me, be required to purchase Health Care Insurance coverage from a US company, even though we don’t live there?  If we don’t buy it, will we face a stiff fine, or jail time?  Frankly, I think that is crazy.  I also think that it is something that has not been considered by those who are considering the law.  There are tens of thousands (possibly hundreds of thousands, I’m not sure) of Americans who do not live in the USA, so this is a real issue that needs to be checked out.

So, what do you think?  When or if you move to the Philippines, what are your Health Insurance plans?  Do you have any plans?  Do you plan to self-insure, since health care costs here are actually quite low?

Give me your thoughts, but please remember, let’s only talk about how this legislation affects expats.  No name calling, it’s just now what we do here!

The Mighty Mosquito

You’ve heard the old saying that the pen is mightier than the sword, right?  Well, over the past several weeks, I have come to find out that the mosquito may just be mightier than either the sword or the pen.  Because of a mosquito, I have been sick for three weeks already.  And, when I say sick, I am not just saying that I didn’t feel well, I have been seriously ill.

Three weeks ago, I thought I had a cold.  I had sniffles, a slight fever and a sore throat.  It took a week or so, but it passed.  For a couple of days, I felt OK.  Weak, but OK.  Then, I had a couple of events to attend to one day – a breakfast with a friend, and then lunch with another friend the same day.  By the end of the day, I was so tired and weak that I could hardly even stand up!  I figured that I was not quite over my cold yet, and had overexerted myself.

After this overexertion, I had a higher fever, and was very, very weak.  It had been years since I had felt this sick.  I don’t get sick too often, but when I do, it tends to be somewhat serious.  Well, this time, as it turned out, it was quite serious.  I found out that what I had was not a common cold, but rather, I had Dengue Fever.  I should say, I have Dengue Fever, as I am still sick as I type this.

The next thing that happened was rather strange… I suddenly broke out with a whole bunch of red dots on my legs, and a few on my chest and face.  I wondered if it was measles or something, but I’ve already had that when I was a child.  I saw a doctor, and he told me that it was not measles, but rather, I was in the final stages of Dengue.

So, right now, the disease has passed, for the most part.  It can take weeks, even months, though, to regain your strength after going through Dengue Fever, so I still have  a ways to go before I am feeling normal again.  It’s a tough disease, and it really saps you of all of your strength!  Sometimes, you have so little strength that it is all you can do to just stand up.  Doing anything more than that can seem almost impossible.

What are the symptoms of dengue?

Well, there are many symptoms, and you may have some or all, it just varies.  For me, it started out with severe headache, cough, sore throat and sniffles.  I only had a minor fever, although the next week my fever was higher, but still not severe.  Also, I experienced some nausea and stomach discomfort.  Like I said, the red dots on my skin too, which were very numerous.  Pain behind my eyes was quite severe, like a lot of pressure behind the eyes.

With these symptoms, I first thought I had a cold.  Later, I knew it was too severe for a cold, and I thought I might have H1N1, Swine Flu.  Truth is, I think that Swine Flu, from what I’ve heard and read, is probably a lot milder than Dengue is, though.

What are the treatments of dengue?

Truth is, there are no treatments for dengue, officially.  No type of medicine will cure it.  There are “folk” remedies, though.  I have been using two.  Firstly, my friend, AmericanLola e-mailed me to tell me that one thing that is helpful is to make a juice by crushing the leaves of a papaya tree, which I’ve been doing.  It is some bitter stuff, but I drink it by the shot glass!  I don’t know if it works or not, but I’m trying it.  Another folk treatment is to make a tea from tawa tawa, a weed.  I did that once, and drank part of it.  I really didn’t like the stuff, though.

How do you catch dengue?

As far as I know, there is only one way to catch Dengue Fever, and that is from a mosquito bite.  It is from a certain type of mosquito, not just any mosquito.  This type of mosquito bites during the day, which I am told others don’t.  Also, only the female mosquito bites, which I never knew before.

While I cannot be certain, I believe that I may have picked up the virus when I visited Dinagat Island a few weeks ago.  I say this because I got sick about 4 days or so after I got back, so it would seem logical that I got the bite either on the Island, or perhaps on the bus while I was traveling.  That said, it is only my guess, and I could have just as easily picked it up right here in Davao, I just don’t know for certain.  I have no memory of being bitten by any mosquitoes, but it must have happened.

Dengue is not contagious, so one person cannot pass it to another.  You only get it from the bite of this certain mosquito.  I am thankful that I was not able to pass it along to anybody else in the family.

If you are visiting the Philippines, or any other tropical area in the world, I would recommend that you avoid mosquitoes at all possible cost.  Use some kind of mosquito repellent to keep them away from you too.  Believe me, you don’t want to catch Dengue!  It has proven to be a very uncomfortable sickness, and I hope you can avoid it – I wouldn’t wish this upon anybody.

Oh, if you are thinking of getting a shot to immunize yourself against dengue… don’t even bother.  There is no immunization against dengue.  The only way you can prevent the disease is by not getting bitten by any mosquitoes.

Torture or Healing?

I’ve been wanting to try reflexology for quite some time.  I finally decided to do it a few days ago.  I had heard it was painful at first and that it could heal all kinds of things.  I don’t know if it heals anything yet but I can attest to the pain!

Reflexology in The Philippines

The process is a little bit science, a little bit magic and a little bit torture.  Jessie even said, “I like to see you in pain.”.  LOL  She even took my picture to document the experience.  We are not married officially but its beginning to feel very married.  It was all in good fun.

I did it part because I wanted to experience the culture of the Philippines.  This happens in other parts of the world but its much more common here than in the USA and probably most other Western Cultures.  In Memphis, where I had lived for the last 25 years if you wanted reflexology you went to the fortune teller.  I don’t think pain is a normal part of reflexology in the west either.  Perhaps others can comment on that.  I don’t have first hand experience, I’ve just had several people from the west tell me it doesn’t hurt.  Trust me on this, here, it hurts!

The torturer, otherwise known as the reflexologist has this wooden device that he pushes into various pressure points.  There is a specific place for the heart and for the thyroid and other organs.  I just remember those too the most as the memory of the pain lingers.

Now its not like going to the dentist without pain meds or anything but it does hurt.  Most of the time it feels quite good.  The reflexologist worked on each foot for 20 to 30 minutes and I told him lets make it 20 minutes. LOL

He doesn’t charge for it but will accept gifts.  He is considered a healer and doesn’t “demand” money for it.

They say this cures everything from appendicitis to heart disease and circulatory issues.  I find that a little hard to believe but we’ll see what happens.  I have a lot of pain in my calves and I can see where this treatment might help with that.  After one session, the pain in my left leg is gone.  The pain in my right leg is still significant.  I take a lot of medications for this one issue, no pain meds other than an NSAID, and it would be great if I could stop taking it.  Time will tell.  We paid him P100 per person as that is what someone suggested.  Maybe it should be a bit more considering how long it takes.

Henry, the reflexologist, is also a plumber, electrician, appliance repair man and probably a carpenter too.  He fixed an electrical outlet for us after he was done with our feet.

What about you, have you experienced reflexology in the Philippines? How about some place else?  Please tell me about your experience.

Thanks,

Rusty
Read more about my experience with reflexology on Hey Joe! Living in the Philippines!

Generically speaking…

If you elect to live in the Philippines, one of the things that you have to keep in mind is health care.  I mean, health care is relatively inexpensive here, but the costs can add up.  You can get certain types of insurance, but the odds of having a medical plan as comprehensive as what you may be used to is not that likely.

I mean, for many expats, they may well be leaving behind a government medical plan.  For example, Canadians, British and most Europeans have free, or low cost medical care as part of their Citizenship.  Americans, for the most part, have health insurance through their employer.  Yes, some Americans are uninsured, but that is not what we are here to discuss.  It may be a hot political issue back in the States, but that has nothing to do with Living in the Philippines.

Most expats here have no real medical coverage.  For daily medical needs, that is generally not that big of a deal, because doctor visits, even hospitalization is very inexpensive here, especially when compared to that in the USA.  I mean, you can generally go for a doctor visit here for P200 to P300 or so, even with a specialist.  When it comes to any kind of major medical problem, though, you could be facing some large bills.

For example, in 2001, I suffered a stroke here in the Philippines.  I was hospitalized for two weeks, one week of it was in Intensive Care.  After that, I had a couple months of daily therapy at home from a physical therapist.  My hospital bill was less than $4,000, very cheap for that level of care.  My daily visits from the physical therapist were p100 per visit (at my house!).

If you have any chronic illnesses, though, that require a regular regimen of medications, the bills can add up.  I mean, you might not be hit with a huge bill at one time, but week in and week out, the cost of medications can really add up.  Consider also that most expats who decide to move here to live are already at retirement age, or approaching such an age.  People of such an age commonly may need a number of different medications to remain healthy.

In my case, I take several different medications on a daily basis.  A couple of the medicines that I take ring in at about $1 per pill.  Not a huge amount, but if you can get it cheaper, why not?

In the Philippines, for several years there has been great debate about introducing more generic medications to bring down the cost of drugs.  In the US, generics have been widely used for decades already, and are very effective.  But, in the Philippines, generic medications can be very difficult to obtain.  If you go to most pharmacies, they have the brand name drugs, and no generics.

Recently, though, I found out about a Pharmacy called The Generics Pharmacy.  The Generics Pharmacy sells only generic drugs, and their prices are very, very cheap, compared to the regular drugs in other pharmacies.

As an example of the kind of prices you can expect, sometimes, if I get a bad infection, I take Cipro, a very strong antibiotic.  Here in the Philippines, Cipro is generally sold under the name “Ciprobay” which is manufactured by Bayer.  At The Generics Pharmacy, they have Ciprofloxacin, which is the generic equivalent.  I always buy Cipro in the 500mg size.  The Bayer version is around P80/tablet, or it was last time I bought it.  If anything, it is probably more now, as I haven’t used it in probably a year or so.  At The Generics Pharmacy, the price of a 500mg tablet of Ciprofloxacin is P6.  Talk about a savings!  That is more than 90% off of the price of the non-generic drug!

There have been some drugs that I have checked where the savings was less.  On one of the drugs that I regularly take, the savings is 25%, but all of the others are much higher in savings.  Even a savings of 25% is a huge amount!

The Generics Pharmacy even has a website (linked above) that lists all of their prices for every medication that they carry.  They have nearly 400 branches, nationwide too.  If you are in the Visayas or Mindanao, you will pay 7% more than the cost shown on the site, but that is only a minor amount compared to the savings that you will gain.

Here in Davao City we have two branches of The Generics Pharmacy in town already, and a number of others preparing to open.

I believe that once this Pharmacy gains a strong presence in the Philippines, and Filipinos get to the point where they trust Generic Drugs, it is going to have a huge impact in bringing down the prices of medication in the country.  Right now, if you buy non-generic medications, the price here is sometimes more than you would pay in the USA.

H1N1 and the Philippines (updated)

Remember a month ago, maybe 2 months ago?  H1N1, or Swine Flu as it was called back then was a hot topic on the news.  Mexico was ground zero for the swine flu.  The USA was not far behind, with plenty of cases of Swine Flu showing up in many US States.  There were many deaths in both the USA and Mexico.

It didn’t take long, and “Swine Flu” was out of the headlines.  Instead, the H1N1 Virus took over.  It was the same thing, but the name was changed, reportedly because Pig Farmers complained and didn’t want their business to suffer because of the name, “Swine Flu.”  So, instead, newspapers and TV news reports were reporting about H1N1 Virus, but it was still at the top of the headlines.

These days, though, when I watch foreign news channels like CNN or others, H1N1 is rarely a topic any longer.  However, the virus has not gone away.  In fact, it seems to be getting even more widespread.  I still hear of occasional cases in the USA, as a matter of fact, another death was just reported in Washington State.  Other states are reporting additional cases of the virus too.  Idaho.  Texas.  Michigan too.

The thing that is worrisome  in terms of life in the Philippines, though, is that the Virus has moved to the East.  China has experienced more than 70 cases so far.  How about this one… more than 1,000 cases of H1N1 in Australia!

The Philippines was one of the few H1N1 free countries in the early days of the Virus, but these days H1N1 seems to be spreading fast in the Philippines too.  As a matter of fact, last week, when a Philippine Senator had a fever, causing her to cancel a hearing, rumors broke out that she had been striken with the dreaded virus.

Now, the Philippine Department of Education is even postponing classes in many Universities as a precaution toward stopping the spread of the H1N1 Virus.  Feyma and I have laughed about it a bit, wondering why University classes would be suspended, but kids in Elementary and High School have a full class schedule!  Are University aged students more worth of protection from the virus compared to their younger siblings?

Latest statistics show that there have been 33 reported cases of H1N1 in the Philippines to date.  So, I am wondering, why has world news coverage of this virus gone way down?  It is still affecting the First World, and is now spreading into locations that had no such outbreak before.  To me, this would tend to indicate that the virus is spreading much faster than it was a month or so ago.  So, why is it being under reported now compared to 4 or 6 weeks ago?  Was it just the hot topic of the day when the outbreak first occurred, and now it’s old news?  That is my bet.  But, if this thing is spreading like wildfire, and still causing deaths, this old news could turn into disaster.

In a place like the Philippines where people live in very close quarters, where animals are cramped in very near to the family, this swin flu could indeed become a disaster.

Precautions are being put into place in the Philippines.  A largely Catholic country, some of the measures are somewhat unbelievable to me.  At some Churches, hand holding during the ceremony has been banned.  The Archbishop of Manila issued an order that Communion is to be given only hand to hand;  no hand to mouth contact is now allowed during the Communion sacrament.

The truth is that a lot of people in the Philippines are very scared of this virus, and rightly so.  For a long time, way before the virus had been reported in the Philippines, I already saw people wearing masks in public.  Remember, the SARS Virus and the Bird Flu were widespread in Asia over the past few years.  On both of those viruses, the Philippines was spared.  However, on the H1N1, the Philippines is now the hardest hit nation in   SE Asia.  So, it is right to take precautions at this point.

What can you tell me?  If you are in the USA or maybe in Europe, is this virus still in the news where you are?  Or, as I have noted, has it kind of died down in the amount of coverage it is getting?

Update June 8, 2009, 10am Philippine Time: Philippine news just reported that six new cases of H1N1 have been confirmed in the Philippines, bringing the total number of cases to 39.

Update 2 June 8, 2009, 8pm Philippine Time: Seven more confirmed cases, 46 confirmed cases as of now.

Filipinos only want your money

Filipinos are only out for your money.

I hear it every day from a lot of foreigners.  I hear it from people I meet with face to face.  I hear it from people who e-mail me.  I remember when I first got married to Feyma.  So many people told me – “Oh, she only wants a green card.“  Imagine, if a lot of people told me that to my face, how many people were thinking it but just too embarrassed to speak up?  Lots, I am sure.

Well, Feyma and I were married nearly 19 years ago, and we are still married.  She got her green card, but she still stayed with me.  She even became a US citizen and stuck by my side.  Even when I convinced her to move back to the Philippines, she did so.  Funny how that happened, but so many people told me that after she got a green card she would be out the door.

What about this, though, that people say Filipinos only want money? Do you believe it?  I mean, when you go to the market, they sometimes add an extra P5 onto the price because of your white skin, they must be out to take your money.  What about the “white man tax” that so many foreigners talk about.

Well, let me tell you about something that happened this week, and you can think about it, and decide if you think that Filipinos only want money from the foreigners.

This week, one of my sisters-in-law came to visit, and she brought along her young son, who is 4 years old.  He is a cute kid, and really a polite and friendly little fellow.  Of course, I know him, but I don’t see him very often.  I enjoyed spending some time with him, though.  I like kids, and it was fun to play with him, give him a few special treats that he would not get at home, etc.

There was one thing that reallly bothered me a lot about him, though.  His teeth were absolutely rotten.  I mean they were black with decay.  His teeth were among the worst that I’ve ever seen, and it made me sick to even look at them.  Not only was it a sickening site literally, but to think that this kid was family, and in this kind of condition was something that made me feel badly.

I say this not to embarrass anybody, but am simply stating a fact.  I won’t name anybody involved, and none of the readers of this site would know who the kid or his parents are anyway.

The next morning after they had arrived, I had a talk with Feyma about the youngster.  I told Feyma that I wanted the kid to be taken to the dentist.  We have a regular dentist here in town that we use, and whom we also recommend to a lot of readers who visit here.  Her name is Dr. Lourdes Lebosada.  I consider Lourdes not only my dentist, but a good friend as well.  She has always taken good care of me when I’ve used her for dentistry, but also has been friendly and helpful to me whenever I have encountered her.

I decided to come along with Feyma and her sister when we took the young man to the dentist.  I wanted to see Lourdes, and to talk with her about what would be needed to get this kid’s teeth straightened out and make him healthier.  To be honest, when I saw Lourdes examining this child, I felt bad that Lourdes even had to put her hands inside, or even near, this kid’s mouth.  It is something I wouldn’t want to do.  But, Lourdes did it, all the while with a smile on her face and a pleasant attitude too.  I asked her what needed to be done to get this kid on the right path.  She recommended that he have a fixed crown put across his front teeth after she did some work to clean the teeth up and stop any decay.  I asked Lourdes, how much will this cost me?

I was not only surprised, but so grateful to Lourdes when she said to me that she would do it as a favor to me.  I have done things for Lourdes in the past.  Last year, I helped her set up a website, and put up some web advertising for her, and in exchange she got all of my dental work all caught up.  Let me say here, I am not writing this as any kind of advertisement for Lourdes.  I am genuinely writing this to show that Filipinos are not out to take money from foreigners.

Today, my nephew came home from the dentist with all of his teeth fixed up, a bright white smile on his face, and looking great!  Even at just 4 years old, I believe he was very self conscience about his teeth before, because I never really saw him smile much.  Today, he was all smiles.  It made me feel really good to see that.

The final thing that we had to do, though, was to teach this kid about how to properly brush his teeth.  I also told him that whenever I see him I am going to be checking his teeth, so he better make sure to take good care of them!

I was hesitant to write this article, because I didn’t want to make it seem like I was belittling my nephew or his mother.  But, this is something that made me feel so good in so many ways, that I just felt I needed to write about it.

So, anyway, next time you hear about the “white man tax” or how every foreigner is overcharged, think about this.  The dentist did this work for me for nothing, free, gratis.  Do you think she was “out for my money?”  No, she was not, and it’s important to remember that the vast majority of Filipinos are not out to rip you off.  Yeah, there are a few who will try to take advantage of you.  But, think about it… aren’t there people in your home country that take advantage of others?  It is something that happens everywhere in the world, not just in the Philippines.

Thank you very much, Lourdes, if you read this.  You are a kind lady, a good dentist, and a good friend.  Your generosity will certainly be repaid some day in some way.  I am very confident of that.

Hospital for Migs

After only one day of attending a workshop Migs came home tired and within a few hours broke into two solid days of hard fever that finally broke, but left him so weak and dehydrated, followed by more unpleasant side effects.

On the third day he looked so dehydrated and weak and was passing blood too, so off to our great local doctor who looked him over and said he was being admitted now to hospital.

We found out later that some of the symptoms were associated with Typhoid, needless to say it was not, but it was a very serious parasitic infestation that was causing internal blood loss, lowered his blood pressure and added to his dehydration leaving him in a a dangerous state.

The hospital we were admitted to did the laboratory checks and within minutes had him on drips for Parasitic infestation, dehydration and other antibiotics, and this was for fours days non-stop.

Being in a hospital can be very confusing for people like me from the UK, where all our medical services are free, and now everything and I mean everything costs from syringes to plastic containers, let alone the medication and accommodation itself.

It is also confusing that some items are demanded to have cash before you have them, others are put on a charge account that you sign but you do not get a copy of, so make sure you keep a note as you go as in the rush to get things done you can lose where you are and who you are paying.

The patient is alone! I mean that the prescriptions are left with the patient. If he has no money or is too unwell to get the medicine treatment just seems to stop! If he needs help there is no buzzer or alarm, and most of the staff are just doing one job. Like a nurse will come in to check the pulse and blood pressure. Minutes later will come in to check the drips. Another will come in and check recorded information for fluids taken and released. Another will bring in prescriptions.

I was a little niggled as no one could answer questions, and I could not even on the first day find out who was seeing Migs and who was actually prescribing the medication and why? No matter what one person would tell me another would give an alternative answer and so on and so on. Best advice here is to stay calm, do not get rude and just keep asking, and eventually the right person will appear, in our case the initial doctor who sent him to hospital was involved, and she is excellent in communicating and is very matter of fact and no messing.

I was a little worried as there was no soap, no towels or even toilet tissues provided ,and on many occasions I witnessed things being done to the patients without gloves. There was no problem with the amount of staff on duty, but at one time a visitor came to see Migs and spent half an hour outside our room and no one at the front desk knew where Migs was or what room he was booked into!  As it was, we were 6ft away from the nursing station that had put him in the room.

A nurse in my home country sits and talks with you and answers questions and communicates the instructions of the doctor. However I did not find that here, its almost like the person is just left in the room and is treated in a robotic methodology.

Migs by day two was getting stronger, his blood loss had stopped and his blood pressure was up, and thankfully the fluids being pushed into his body were solving the dehydration. You must do this slowly, it cannot be rushed. He was so wanting to leave the hospital but the doctor said no, and we both trusted her, even if the cash was mounting hour by hour.

The room was adequate, nothing like TV or books and even meals that looked inedible to me as a fish head for breakfast is not my idea of getting a good meal. Just a matter of taste I assume.

But I noticed Migs could not eat most of the food so I had to bring food in from the outside along with water, as non is supplied.

Lucky for us, Migs was released after only a few days and is now almost back to normal, but it made me think how could I survive in a hospital like that if I need some serious problem resolved. I am not just talking financially but emotionally too!

I am just talking about the one hospital I went to which is a semi-private hospital, I can assure you that some of the public hospitals in the Philippines are something that people from the West just would not believe.

But the good news is that myself and Migs are off to Thailand in a few days for a rest, well maybe just a little rest.

I will send you a postcard.

Philippine Healthcare

In general, I feel that health care here in the Philippines is excellent.  There are a couple of things, though, which I want to look at today.

Just a few minutes ago, I got an e-mail from a Philippine government agency.  I am not going to identify the agency, because what I say might be deemed embarrassing to them, although I do not intend it that way.  I am not saying anything bad about this agency specifically, because what I am going to address is the norm throughout the Philippines, not just in this one area.

One of my websites serves as a distributor of news and information for any group which wishes to provide me with their news or information about events in their area.  Because of this, I received this e-mail which announced information about some health care matters in the area.  Basically, they were sending me information about two different matters in the area of health care:  Circumcision and Tubal ligation.  Let me address each of these issues individually.

Did you know that Philippine youth who get circumcised (males, of course) do not get that at birth?  Well, maybe a few do, but the vast majority of young men who are to be circumcised have it down at that age of maybe 8 or 10 years old and up.  Some have it done as late as 18 or 19 years old, although that is not the norm.

A few years ago, I was invited by the US Military to attend a medical mission that they were conducting in Marawi City, Lanao del Sur.  Marawi is a Muslim City, with probably a minimum of 95% of the population being of the Muslim faith.  I was excited to accompany US troops on this mission, because I had long wanted to visit Marawi, but had been cautioned against it sternly for safety concerns.  Well, being with a group of US Special Forces was probably about the safest way to visit the area, so I gladly accepted the invitation!  To my surprise, one of the services being offered by the American doctors on the mission was Circumcision.  The thing that was really surprising is that they had two female American doctors circumcising these Filipino Muslim youth!  I, along with some other photographers and journalists could just stand there and watch as a dozen or so Muslim boys were laying on a big table and all being circumcised right there in plain view!  It was quite an experience for me to witness this, to say the least.  The young men were not put under anesthetics at all, and a piece of newspaper with a hole cut in it was used to cover the area, with their member put through the hole to expose it for the procedure.  It was not what I was expecting!

What do you think about this practice, though?  During the years when I was born, most males in the US were circumcised, but it was done at birth, not in our years of puberty.  As years passed, it has come to the point where many medical experts now say that male circumcision is not really medically necessary, and fewer and fewer are being circumcised in Western countries now.  In the Philippines, though, it is considered shameful for a man not to be circumcised.  As a teenager, the young man will be chastised by his peers if he has not been circumcised.  For me, I am of the mind that if I had kids again, I probably would opt to not have them circumcised, I don’t think that it is medically necessary.  However, if circumcision is to happen, I believe it should happen at birth, not when somebody is 10 or 15 years old.  Imagine how traumatic that must be for the kid!

The next issue that was addressed in the e-mail I received was that this area was offering government sponsored free tubal ligation for ladies who wished to avail of the service.  Of course, population control is a huge issue in the Philippines, and I believe it is a good thing to offer such a service to poor families who cannot afford it.  After all, it is usually the poor families who have the largest number of children, and of course they are the ones who can least afford it.  Of course, the Church is against these kinds of programs, and they fight it very strongly.  Take a look at the photo at the left.  This is a photo of the women who have chosen to take advantage of the free service, and they are preparing to go for the operation.

Notice anything unusual?  The ladies are all laid out or sitting on the floor!  Can you imagine seeing this in a hospital in a western country?  The hospital administrator would be fired.  The government agency sponsoring this program would be investigated, maybe even jailed for the conditions!  It is hard to see in the photo, but it appears that there is cardboard on the floor, and a sheet or some kind of cloth on top of it.  How sanitary is this?  I am not a doctor or any kind of medical expert, so I cannot say, but from the things we have all learned since a young age, it would not seem to be the best conditions for a group of patients about to undergo surgery.

Of course, it’s a good thing that these ladies are being offered a free opportunity to control their family size.  I just wonder, though, if the medical conditions present couldn’t be improved a little bit.

What do you think?

Travel Wellness

This week, I was traveling in China and got very ill. Now, as much as I traipse around the world, I occasionally still pick up a minor bug here or there. Travel is stressful, and you are in unfamiliar cities, not speaking the language, strange foods, and so on. This was not the first time I have been hospitalized while traveling for work. Two years ago, I picked up a nasty bug in India and spent the night in a hospital in Paris around three days later (My first tropical disease!). This time was different, though. It really scared the crap out of me. I’ll relate what happened, and give some tips to keep well in your travels.

I generally have a pretty good constitution, rarely getting seriously ill. Once in a while, I’ll eat something bad, or get a migraine from too much stress, but I usually have a fairly decent resistance. I arrived in China on Sunday morning, generally feeling OK, but a bit tired (normal). I had a three day conference to attend, with some very large customers there. Monday comes, and it is a good day, with some important meetings going well. I wake up Tuesday morning, not hungry, and start the conference. Around 10:00 that morning, I’m really tired, so when the conference breaks for lunch, my colleague and I eat a bit, and I’m feeling better. 3:00 comes around and I’m sweating buckets. I deal with my last meetings, take my leave, and I head up to my room, hoping to sleep it off. Around 6:00 I am jolted awake, unable to breathe or speak, 41 degree fever, with stabbing pains in my kidneys. I managed to ring the front desk, and when they heard me grunting on the phone they called paramedics. In China, paramedics take 45 minutes. The hotel concierge sent someone to the pharmacy to get oxygen and I could stutter a few sentences. The paramedics load me into the ambulance, telling me that I am having a massive heart attack and that I was probably going to die (What bedside manner!). This diagnosis was wrong.

I am not one who was scared of death so much. My only concerns were about Becky and Juanito. The hotel concierge rode with me in the ambulance, translating the Chinese, and calling Rebecca, my mother, and my Boss (I thought I was not going home.) They took me to the Shanghai East International Hospital, staffed by Western doctors. It took the hospital about 2 minutes to decide that I wasn’t having a heart attack. So, what did I have? It turns out, a very nasty respiratory tract infection, probably caught while flying on an airplane, but impossible to tell. Three days in complete misery in hospital, and they decide they want to check me for swine flu. The doctor didn’t really think that I had swine flu, since I hadn’t traveled to any infected areas, but here’s where the politics come into the picture. Most governments do not want this flu in their borders. So, Beijing issued a directive that all tests were not to be done at hospitals, but at a central location in Shanghai. The problem? Since I had SOME flu symptoms, I could, possibly, end up being a guest in China much longer than I wished. I convinced them that I needed to return to the RP, they discharged me, and I spent the day recuperating at the hotel. I’m home now, fever largely gone, but weak as hell.

Now, considering where I travel, and how often, it is amazing that I am not ill more often. I spend a lot of time on airplanes (over 150 flights per year) and in airports, in closed environments, surrounded by people who may have God knows what. When I get where I am going, sanitary conditions range from good in places like Singapore or Japan, to abysmal in places like Bangladesh or Indonesia. There are hundreds of mosquito-borne, water-borne, and food-borne illnesses out there and it is impossible to protect yourself from all of them.

How does all of this relate to the Philippines? Well I see many people on this blog asking about injections and health. There are many places in the Philippines that can make you sick. Some suggestions for staying well:

Water: Not all water in the Philippines is drinkable. In fact, I would strongly advise most visitors to drink only bottled water if they are only here on a short trip, particularly in the provinces. That includes brushing your teeth and ice in drinks. Most instances of “Delhi Belly” or “Montezuma’s Revenge” come from drinking contaminated water. Even if you see Filipinos drinking the water, it is best not to follow suit. By living here, their bodies have developed some natural immunity. In Manila, Davao, and several other cities, the water is generally OK, but many buildings have old plumbing systems, and you really just do not know.

Food: Use some common sense. Wash the fresh fruit you just bought on the side of the road (most fertilizer is “organic”), and peel it yourself. Carinderias and street food are often not safe. Be especially careful if you see the food sitting out in bowls…. It is often not reheated to sufficient temperature to kill all bugs. Temperature will kill most bacteria… If it is served hot, you are probably OK. Typhoid and Cholera are still present in the Philippines, both of which are food borne and originate from poor sanitation. Both are also present in raw shellfish, so if the fish comes from dirty water, eat it cooked (I am thinking the oysters and clams in Manila Bay here… best to pass on these). Most hotels and chain restaurants are safe and sanitary. MANY carinderias are also sanitary… Again, if it looks dirty, it is best to pass, regardless of how good the food looks.

Mosquitoes: Dengue is the big one here. No cure, you’ll wish you were dead, and it is endemic throughout the Philippines. Malaria is here, too, but not as common. There are also numerous types of encephalitis here. These are more of a concern in rural areas. In Manila, not so much. Malaria is preventable, but you need to take the prophylaxis periodically. No injections in advance. Your best protection is to use repellent containing DEET, and carry a mosquito net for sleeping if you will be “in the sticks”. Also, mosquitoes are more active at night (dusk), and are really bad if you will be near rice paddies or in jungle areas.

Rabies: Leave the stray dogs you see everywhere alone. They also carry ticks, which can carry a whole host of diseases. I got inoculated against rabies a couple of years ago from a new vaccine once I started traveling to the developing world.

Tetanus: Of all the injections, make certain your tetanus shots are up to date. This is easily preventable.

Hepatitis: Very common here. Get the injections.

STD’s: Leaving the morality out of the discussion for a second, if you plan to indulge in the “nightlife”, keep safe, even if unsafe options are “available”. I remember reading that over 1/2 of the girls at the various KTV, massage, etc. in Manila are infected with some form of STD. Get the hepatitis vaccination. Also, keep in mind that many of the girls have several customers in one night. This is not Amsterdam or Hamburg where there is medical supervision and regulations. TB is also still present here, despite largely being eliminated in the West. Get your TB vaccination, if you don’t already have it (It is also transmitted by air, so this vaccination is really not optional. Becky’s nephew caught it last year in the province. He is 4 years old).

Flu: I question if the masks really do much. Rebecca carries a little bottle of the alcohol gel with her in her purse. just try and keep as clean as possible. Get the flu vaccine each year if you generally are susceptible.

Others: The tropical disease I picked up in India? The HEPA virus, found in animal feces. It is in the air in hot, dusty, India, and enters through your mucous membranes (In my case, my eyes… I rubbed them while walking in a dusty area).

Conjunctivitis, known as “sore eyes” here or “pink eye” in the States, is very, very common here. Try not to rub your eyes, and carry a small bottle of  Visine with you.

There are poisonous snakes in the Philippines, including small cobras. Again, use common sense and wear long pants / boots if you will be walking through weeds and such. Carry a snake bite kit with you if you will be in rice paddies or very remote areas. (One of Becky’s uncles nearly died from a cobra bite last year… it only managed to get one fang into him very briefly, so not as much poison.) There are also poisonous sea snakes here, that are generally timid, but fishermen will sometimes get bitten (Becky’s brother is really careful pulling in nets.)

I read that there are still occasional cases of plague in the Philippines. Now, I wouldn’t panic about this, but there are rats and mice everywhere here. Our compound garbage bins are infested with rats, and we have traps in the house after one came up our washing machine drain.

Keep in mind that if you are unfortunate enough to get ill here, there are many good doctors available in the cities, in particular, Manila, Davao, Cebu, Angeles, and Subic. However, in the provinces, the quality and availability of medical care drops drastically. Before travelling here on a visit, I recommend visiting a doctor who specializes in travel medicine or tropical medicine and getting at least the basic vaccinations or making certain you are up to date. None of the ones I mentioned are unusual in the States, except perhaps malaria prophylaxis, which the doctor can recommend. One other note: A big part of my getting better in China was the attentativeness of the hotel staff in Shanghai (Intercontinental Pudong): They really went above and beyond what they needed to do. When you are looking at price only, regarding hotels, the Western brands usually are very helpful in keeping you safe and healthy and the extra cost can pay dividends. Also, the hospital bill, though cheap by American standards, approached USD 4,000. Travel insurance will normally cover such expenses, and can be a bargain. Do I always buy it? No. Not to developed countries, and my trips are usually just a few days. But in the developing world, it can be well worth the additional expenses.

Different attitudes

As Bob mention on his column a few days ago, the highlight of our trip to Father Franco’s place was meeting new people especially the 3 ladies who are from Peru. It was really nice talking to them, even the mom although sometimes we had a hard time understanding each other. We did enjoy talking about cooking which we both loved to do. She shared to me some recipes they do in Peru and I shared some stuff I cook here the Pinoy food and the foreign food. She’s looking for a place to buy some ingredients and I told her where I usually buy them.

One thing I asked Mama Cela is whether she would want to live here for good? Marianela interpreted my question to her mom. Mama Cela answered me back without hesitation that she definitely would want to live here for good. I asked her if ever she will get sick and be ill would she want to stay here and be treated here or would she want to go back to Peru? She said that she wants to stay here and be treated here. She said its also cheaper here to have a nurse 24 hours. She really is comfortable living here. I could really tell that they are happy here. The only thing she said that she’s not so happy sometimes the communication gap. She had a hard time explaining to people stuff that she wants. I guess also she’s missing her grandkids in Peru. But she said all in all shes happy living here.

Then yesterday I talked to my mother-in-law and I was talking to her about the ladies that we meet. I told her that Mama Cela really liked it here and stuff. Mom immediately told me that she never would want to live here because its too hot for her. She said she would rather suffer the cold weather than the hot weather. Wow, that was a shocked to me, because we already talked about this subject before that if time comes for her to be taken care of that she would be here in the Philippines and stay here. We don’t want her to stay in a nursing home there, and I know she doesn’t want it either. She said before that she likes the idea of having the 24/7 care here that she knows she can afford to pay. I think Mom really is scared to be away from the States right now because of the economic crisis. I had a feeling she thinks it is so bad here because of what happening now in the States. When she was here for a visit she even stopped taking some of her medication because she was feeling better. Almost all her medication that she is taking can be bought here too.

I hope that she will change her mind later. I know that Bob’s brother and family don’t have the time to take care for her later. I don’t blame them. They have to take care of themselves too.  Hiring somebody to take care of her there will cost her a lot of money. Here, my family also told me that they will help us take care of her. If she feels that she wants to stay in the US when time comes up to her. Maybe her family there can take care of her too. Anyway I hope and pray that its still a long time for that to happen. Shes still young. I want her to enjoy her grandkids right now.

Mabuhay!

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